US report says medical errors are the third-leading cause of death – but is this helpful or even true?

Researchers from John Hopkins University, claim that over a quarter of a million US deaths are down to medical errors every year. This worrying figure is only eclipsed by heart disease and cancer.

But key to this is the definition of a medical error.

I would argue that medical errors are cases where the evidence at the time should have led to a different course of action. I’ve heard it said that hindsight vision is always 20:20 – and it is important to remember that. An error is a mistake not a lack of psychic ability.

There are two fundamental problems with the figures in the John Hopkins reports – firstly, they have extrapolated from very small studies. Anyone who has designed a trial knows the importance of having a suitable sample size.

In this case, 35 deaths were multiplied up to 251,454 – that’s quite a leap of faith!

Secondly, the studies cited in the paper, do not always accurately distinguish between adverse events and errors.

Adverse Events (AEs) happen relatively frequently in healthcare. They can range from adverse reactions to a drug or procedure, to an unfortunate accident that has nothing to do with the treatment being given, eg a trip whilst crossing the road.

The small subset of AEs that are directly linked to a medical intervention usually have an extremely low probability of happening. It is not a medical error to suggest a course of action that has an extremely low risk of going wrong – even if the extremely unlikely then happens.

Of course, it becomes an error (or even negligence) if something about the patient’s specific condition makes the risk predictably greater than usual. Either way, the patient needs to be aware of the risk, however slight.

So why does this matter?

The press loves a bad news story – especially about medical negligence. Anything that undermines people’s trust in the medical profession is sure to be greeted with glee. But this can be incredibly damaging.

Life is a series of risk:benefit judgement calls – and healthcare is no different. Anything that unfairly skews the equation is unhelpful. When it comes to healthcare, such distortion could lead people to stay away from their doctor, with potentially fatal consequences.

Maybe the report should have looked at deaths resulting from failure to follow medical advice instead?